Mefloquine Monday

New documents reveal a possible link between a controversial drug and Robert Bales’ murderous rampage.

When former top Army psychiatrist Elspeth Cameron Ritchie first heard about last year’s massacre of Afghan civilians by a once-respected soldier named Robert Bales, she had a hunch. As she told Seattle Weekly at the time, the conventional speculation—that PTSD or a traumatic brain injury Bales had suffered a couple of years prior was to blame—didn’t make sense to her. As she saw it, neither malady was associated with that kind of horrific violence.

Instead, she thought the culprit might be mefloquine, an anti-malarial drug that has been associated with hallucinations, suicidal thoughts, and psychotic behavior. The drug, also known by the brand name Lariam, was developed with research done by the military. And though the Pentagon has dramatically scaled back the drug’s use, it continues to use it in some units.

The military refuses to say whether it gave the drug to Bales, who was stationed at Joint Base Lewis-McChord and is now scheduled for a sentencing hearing in August following his guilty plea last month in the killing of 16 Afghanis. Army Medical Command spokesperson Maria Tolleson cites privacy issues.

But Bales’ attorney, John Henry Browne, says medical records show that Bales was given mefloquine on each of his three prior deployments to Iraq. Speaking for the first time about the matter last week, he added that he does not yet have complete records of Bales’ deployment in Afghanistan, and so cannot confirm that his client took the drug in the months leading up to the massacre.

Bales himself can’t settle the matter. “When you ask him, he says ‘I took everything they gave me,’ ” Browne said.

Regulatory documents released in the past few weeks, however, suggest that Bales was issued mefloquine on his latest tour. “Now we have some hard evidence,” Ritchie says—a sentiment echoed by retired Lt. Col. Greg Alderete of Lakewood, founder of the group Veterans Against Lariam, who calls the documents a “smoking gun.” Alderate says 1,200 people belong to his group, many of them soldiers who believe they are suffering long-term side effects from the drug.

Strangely, the documents came to light due to events that unfolded in Ireland. Irish TV station RTE was investigating mefloquine’s role in the high incidence of suicide among Irish soldiers. Assisting the station with its research, an Irish anti-mefloquine group obtained a report from the Irish Medicines Board that linked a soldier’s mefloquine use to an Afghan massacre. It was heavily redacted, though. So an American doctor also assisting RTE with its program, former Army epidemiologist Remington Nevin, put in a Freedom of Information Act request to the Food and Drug Administration for its report on the matter. That document came unredcated, according to Nevin. The crucial passage:

On an unknown date the patient who was a soldier in the US Army developed homicidal behavior and led to Homicide killing 17 Afghanis. It was reported that this patient was administered Mefloquine in direct contradiction to US military rules that Mefloquine should not be given to soldiers who had suffered TBI (Traumatic brain injury) due to its propensity to cross blood brain barriers inciting psychotic, homicidal or suicidal behavior. 

Speaking by phone from Baltimore, where he is currently pursuing a doctoral degree at Johns Hopkins Bloomberg School of Public Health, Nevin explains that this so-called “adverse event” report (submitted to regulatory agencies in various countries where mefloquine is distributed) says that the information came from a pharmacist. Nevertheless, Nevin cautions that regulatory agencies don’t verify that the people providing information are who they say they are, or that the information is correct. What’s more, the reports make no claim of proving causality.

Still, Nevin notes of Bales: “Everything he did has been perfectly consistent—almost textbook—of someone intoxicated with mefloquine.” In June, Nevin and Ritchie co-authored a paper in the Journal of the American Academy of Psychiatry and the Law that delves into the research that has been done on the drug’s ill effects—research that they say shows that symptoms like “nightmares, anxiety, and psychosis” are “at least 100 times more common than previously reported.”

Nevin says such effects can be triggered by the use of alcohol and Valium, both of which Bales is reported to have imbibed, along with steroids, before the attack. These additional substances may have sparked a “deeper reaction” to mefloquine, one akin to schizophrenia, Nevin speculates. “You hear voices. You see a child who might look like the Taliban, who might look like the devil.”

Certainly no other compelling explanation for the massacre has come forward. When Bales pleaded guilty in June, he said he was unable to account for—or even remember—what he did.

With his plea, Bales took the death sentence off the table. He now faces a life sentence, although his hearing in August will determine whether he is eligible for parole. The earliest that could happen is in 20 years, when Bales is 68.

Bales’ attorney says he is considering the possibility of raising the mefloquine issue at the hearing. Because Browne only knows for sure about Bales’ prior intake of the drug, and not whether the soldier took it in Afghanistan, he says his legal team has been looking into mefloquine’s long-term effects. The lawyer may soon have even more reason to research the subject. He says he was recently contacted by a soldier—whom Browne won’t yet name—who says he was given mefloquine and subsequently killed his wife and children.

Many reported side effects are far less severe, although still troubling. Alderete, who served in Somalia during 24 years on active duty and now works as a civilian logistics planner at Joint Base Lewis-McChord, says he founded his anti-mefloquine group in 2011 after discovering fellow veterans who had some of the same problems he did, including short-term memory loss, balance problems, and anxiety. Those who served in Somalia made the connection with what they called “mefloquine Mondays,” when they would be given their weekly dose. “I would feel like a veil descended upon me,” Alderete remembers. “Your sense of reality is off for a while.”

The notion that mefloquine can cause long-term effects has prompted a Department of Veterans Affairs clinic in East Orange, N.J., to evaluate soldiers who believe they have been affected. Alderate says he spent several days last fall at the clinic’s War Related Illness and Injury Study Center. He failed a balance test, but was told that mefloquine was not the likely cause. Alderete believes otherwise.

Whatever the truth in Alderete’s individual case, his cause has received a boost with the latest news of the Bales case. And if his attorney does raise the issue at the soldier’s sentencing hearing, the public will likely be hearing even more about mefloquine’s dangers.

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